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“Introduction The antiepileptic drug (AED) lacosamide is chemically composed of acetamido-N-benzyl-3-methoxypropionamide, Selleck SHP099 an amino acid with a molecular weight of 250.3 g/mol, and is highly soluble in water (25 mg/mL).[1–4] The mechanism of action through which lacosamide exerts its antiepileptic effect is unique in that it selectively enhances slow inactivation of voltage-gated sodium channels without affecting rapid inactivation.[1–4] This reduces the long-term availability of these sodium GDC-0449 mouse channels, which results in diminished pathological hyper-excitability without compromising physiological activity.[1–4] Therefore, lacosamide does not completely block voltage-gated sodium channels but, rather, acts as a modulator of these channels.[1–4] With regard to pharmacokinetics,

lacosamide has oral bioavailability of approximately 100% and a very low plasma protein binding rate (<15%); 95% is excreted in urine, 40% as unaltered lacosamide and 30% as inactive O-desmethyl metabolite.[2–6] The maximum plasma drug concentration (Cmax) is reached between 1 and 2 hours following oral administration, with an elimination half-life (t½) of 13 hours, thereby enabling administration

PD184352 (CI-1040) of two doses per day.[2–6] No pharmacokinetic interactions have been observed in various clinical trials with other AEDs, digoxin, metformin, omeprazole, or oral contraceptives containing ethinylestradiol and levonorgestrel.[2–6] The effectiveness and safety of lacosamide have been demonstrated in three randomized, double-blind, placebo-controlled clinical trials conducted in adult patients with focal epileptic seizures. Although lacosamide is approved for use in patients over 16 years of age,[6–8] limited clinical experience exists for younger patients.[9,10] Therefore, our study was conducted to evaluate the efficacy and tolerability of lacosamide in children aged less than 16 years with refractory epilepsy. Methods Study Design This was a prospective, open-label, observational, multicenter study conducted at 18 neuropediatric units across Spain (listed in the Appendix). Patients were recruited by neuropediatric doctors at each participating unit over a period of 12 months, and were eligible for the study if they had already initiated treatment with lacosamide after a lack of response to prior antiepileptic treatment, defined as a minimum of 2 months without a clinical response to previously SAR302503 administered AEDs. Lacosamide had been prescribed because the neuropediatric doctor believed the patient could benefit from its use.